Complications of hip fractures: A review

Table 1 Medical complications after hip fracture surgery

Medical complications		Perioperative incidence	Intervention/recommendation1
Cognitive and neurological	Cognitive alterations	10%	Preventive interventions in high-risk patients
	Postoperative delirium	13.5%-33%	Preventive role of antipsychotics (haloperidol)
Cardiac and vascular	Arrhythmia		Evaluation and care of patients with previous heart affectation
	Heart failure/Myocardial ischemia	35%-42%	Restoration of fluid status to euvolemic. Beta-blockers if necessary
	DVT/PE	27%/1.4%-7.5%	Thromboembolism prophylaxis
			Early mobilization
Pulmonary	PPCs (exacerbation of chronic lung disease, atelectasis, respiratory failure, PE, ARDS)	4%	Evaluation and care of patients with previous lung disease
			Adequate postoperative fluid balance and pain control
	Hospital-acquired pneumonia	7%	Thromboembolism prophylaxis
			Timely diagnosis, adequate antibiotic treatment and accurate monitoring
Gastrointestinal	PGICs (dyspepsia, abdominal distension, reflexes ileum and constipation)	5%	Adequate postoperative fluid, diet, pain and medication management
	Gastrointestinal postoperative stress ulcer/ gastrointestinal bleeding	1.9%	Gastrointestinal bleeding prevention with pump inhibitors
Urinary tract	Urinary retention Urinary tract infections	12%-61%	Urinary catheters should be taken out as soon as possible, preferably within 24 h after insertion
			Timely diagnosis and adequate antibiotic treatment
			Preventive identification of pre, peri or postoperative medical or surgical risk factors
	AKI (prerenal, renal or postrenal)	11%	Timely diagnosis, adequate treatment and accurate monitoring
Hematologic	Anemia	24%-44%	Preventive identification of pre, peri or postoperative medical or surgical risk factors
			Correct hemoglobin level to ≥ 10 g/dL before surgery
			In anticoagulated patients, correct international normalized ratio to ≤ 1.5 preoperatively
			Timely diagnosis, adequate treatment and accurate monitoring
Endocrino-metabolic	Protein-caloric malnutrition	20%-70%	Nutritional supplements in peroperative period
	Diabetes	17%	Maintain glucose levels between 100 and 180 mg/dL
	Vitamin D insufficiency-deficiency		Vitamin D supplementation
Other	Pressure scars	7%-9%	Early surgery fixation (within 24-48 h in stable patients)
			Alternating pressure mattresses, pressure-relieving beds and equipment, aggressive skin care and proper nutrition, prevention-focused nursing

DVT/PE: Deep vein thrombosis/pulmonary embolism; PPCs: Postoperative pulmonary complications; PGICs: Postoperative gastrointestinal complications; AKI: Acute kidney injuries.

¹Each patient needs a preoperative functional assessment, joint orthopedic-geriatric care is of benefit, reducing inpatient complications, length of stay and mortality.